Provider Demographics
NPI:1659130516
Name:TIEN BAO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:TIEN BAO CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:323-264-6296
Mailing Address - Street 1:3800 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-1805
Mailing Address - Country:US
Mailing Address - Phone:323-264-6296
Mailing Address - Fax:323-267-0268
Practice Address - Street 1:3806 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1805
Practice Address - Country:US
Practice Address - Phone:323-264-6296
Practice Address - Fax:323-267-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty